Medical errors—is there a solution?

DR QUIROZ

By Salvador Quiroz

It made all the papers and the nightly news…the Institute of Medicine study released late in 1999 contends that as many as 98,000 Americans die each year due to medical errors—more than from traffic accidents, breast cancer, or AIDS.

New legislation has been proposed to control these medical errors, but that is not enough. Every health care facility needs to be certain that they are doing everything possible to eliminate potential errors, because the bottom line is that medical errors affect patients. There has to be a corrective and preventive action, not only a remedial one.

Most of us think of corrective action as anything done to fix a problem. But if the problem doesn’t stay fixed, it is not truly corrective. In other words, there is a component of prevention here. Corrective action is defined as that taken to eliminate the causes of an existing non-conformity, defect, or other undesirable situation to prevent recurrence. Preventive action, on the other hand, is defined as an action taken to eliminate the causes of a potential nonconformity, defect, or other undesirable situation to prevent occurrence. In contrast, remedial action is defined as that taken to alleviate the symptoms of existing nonconformities or any other undesirable situation.

Russell and Regel use a wonderful example to illustrate these differences:

• When your 20-year old roof starts to leak, you patch the roof and replaster the

ceiling where the leak has caused damage (remedial action).

• When your 20-year old roof starts to leak, you replace the whole roof and replaster the ceiling where the leak has caused damage (corrective action).

• Your 20-year old roof, guaranteed for only 20 years, has not started to leak, but you replace the roof before any leakage occurs (preventive action).

These action processes have to include the identification of problems and their causes, as well as the possible solutions. But if we only correct the visible problems and do not determine the underlying cause, we are performing remedial action. Identifying underlying causes is a process in itself. The key to doing this successfully is not to stop too soon or get caught in the trap of placing blame on any single individual. The creative phase appears when possible actions for improvement are determined.

The goal, then, is to correct problems, ensure that they stay corrected, and prevent new problems from occurring. Ultimately, the delivery of better patient care will be rewarded, so the object of this article is to let the community know that our Hospital H+ has for some time started to implement these improvement processes that lead to better patient care. Who owns the Hospital H+? The answer is, we all do. That is why we always welcome your suggestions.